The Medicines Adherence Challenge

With the loss of patent exclusivity affecting many blockbuster products, keeping skittish patients on their medicines ought to be a strategic priority for Big Pharma—but is it? With many experts openly questioning the effectiveness of traditional approaches to medicines adherence, the National Consumers League (NCL) has stepped into the arena with a new three-year campaign, "Script Your Future," that deliberately targets a more diverse array of stakeholders to attack—and hopefully reverse—declining rates of adherence for three key chronic diseases. In a joint initiative with NCL, Pharm Exec convened n expert panel on Oct. 12 to examine how best to make progress and agree on some practical steps for incorporation in the campaign agenda. A summary of key points follows below. The consensus? Start by influencing the behavior of the people behind the patient. – WILLIAM LOONEY, EDITOR-IN-CHIEF

PHARM EXEC: A barrier to change in health policy is the persistence of "silos:" institutions and the people that represent them simply don't talk to one another. The National Consumers League, our cohost for today's discussion, has launched a nationwide education campaign around medication adherence that seeks to address and reverse this "dialogue of the solitudes." I'd like to begin by asking our NCL colleagues to outline the objectives of its Script Your Future campaign to the stakeholders we have assembled here today—and to our readers.

REBECCA BURKHOLDER, VICE PRESIDENT, HEALTH POLICY, NATIONAL CONSUMERS LEAGUE: The NCL campaign builds on our history of engagement in medication safety issues, where we work closely with the federal Agency on Healthcare Research and Quality (AHRQ), among others. Launched in May, Script Your Future is a patient- and clinician-centered initiative designed to improve awareness about the importance of taking medicines as directed. The focus is to educate the patient and their family caregivers as well as the relevant healthcare professional—from physician, to pharmacist, to nurse practitioner—on good adherence practices in the treatment of major chronic diseases. We've identified three such conditions as priorities: respiratory disease, including asthma and COPD; cardiovascular ailments, led by hypertension and high cholesterol; and diabetes.

WIDENING THE CIRCLE OF ENGAGEMENT

PHARM EXEC: The adherence landscape is well plowed. What marks this initiative as unique?

BURKHOLDER: The campaign has enlisted one of the most varied and diverse range of sponsors anywhere in the healthcare space, with over 100 organizations now committed to endorse our goals and replicate these in their own activities. Partners include pharmacies, insurers, data service vendors, pharmaceutical companies, trade/industry groups, professional associations, patient organizations, interest group coalitions like the AARP, and key public health agencies, including the FDA, HHS, and NIH. This strong multi-stakeholder base, which includes many of you here in this room, frankly marks a break from the narrow approach applied in other adherence programs. Learning from past initiatives, we are also concentrating our resources in a few locations; for now, these include Baltimore, Birmingham, Cincinnati, Providence, Raleigh-Durham, and Sacramento. What each municipality shares in common is a higher-than-normal incidence of the three chronic conditions, the availability of partnering institutions, and a mid-sized media market.

What drives any education campaign is the message. Script Your Future takes as its starting point that our audience is diverse and that no one message works for all. We have invested in patient focus groups to shape an approach built on providing them with answers to three simple thematic questions: 1) What are the individual health consequences of failing to take a medication as directed? 2) What impact can this have on the patient's future, and in particular the family circle—children, friends, and caregivers? And 3) assuming patients do want to have greater say in treatment, how does adherence advance that goal of patient empowerment in relations with physicians, pharmacists, and other healthcare professionals? From this base, we structured a set of initiatives that relate to one overarching message: Initiate the conversation! Insist on talking to your health professional about your medicines. And introduce to that conversation the right questions needed to better manage your condition.

Tools and instructional materials on how to do this are presented in "script" form, in easily accessible formats, led by two new Web-based NCL platforms—one designed for the patient and the other for the healthcare professional in responding to that patient. These rely in turn on other existing resources, provided by our partners; it's an aggregation of the best tools out there. The patient website also has text reminders that patients can sign up for to remind them to take their medicines, and a pledge to encourage patients to commit to taking their medications. In the six target cities, we have local coalitions leading grassroots events encouraging adherence. Many linked efforts are under way with our partners. For example, we have a competition with the pharmacy graduate schools to come up with creative approaches to pharmacy-based adherence. NCL will announce the winner under the sponsorship of the US Surgeon General early next year.